Romiplostim in a Pregnant Woman − Case Report
The following clinical case demonstrates good control of resistant immune thrombocytopenia in a pregnant woman during the administration of romiplostim.
Introduction
Immune thrombocytopenia (ITP) is an autoimmune disease characterized by a significant decrease in platelet count and associated bleeding manifestations. In the treatment of persistent and especially chronic ITP, in addition to corticosteroids and intravenous immunoglobulins, thrombopoietin receptor agonists (TPO-RAs) are also used, including romiplostim.
Case Description
The first symptoms appeared in the patient at the age of 22. There were newly developed petechiae and mucosal bleeding symptoms. A blood count examination showed significant thrombocytopenia (19 × 109/l). Treatment was initiated with prednisolone at a dose of 1 mg/kg/day, and hydroxychloroquine was also administered due to positive anti-dsDNA, with partial effect. Subsequently, intravenous immunoglobulins and azathioprine were tried. Due to the insufficient effect of the treatment again, splenectomy was indicated, with no significant rise in platelet count.
Shortly after the surgery, the woman decided to become pregnant. During the first trimester of pregnancy, she received corticosteroids, but with no effect on platelet count. In the third trimester, treatment with romiplostim was started. After 3 cycles, an increase in platelets to 164 × 109/l was observed, and during the delivery period, their count dropped to 75 × 109/l. The delivery was uncomplicated, and the woman gave birth to a healthy child. Treatment with romiplostim continues post-delivery.
Conclusion
Several studies have shown that the administration of romiplostim during pregnancy is not accompanied by complications in the fetus. Considering the risk of bleeding complications in ITP during pregnancy, effective treatment is very important, and TPO-RAs can offer an optimal solution, especially for patients refractory to the 1st or 2nd line of treatment.
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Source: Payandeh M., Karami A., Karami N., Masgareh J. B. Romiplostim: successful treatment of a pregnant woman with refractory immune thrombocytopenia. Biomed Res Ther 2018; 5 (8): 2565−2571, doi: 10.15419/bmrat.v5i8.465.
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